Smart Health Insurance

The Policy provides for -

Hospitalisation Expenses: Payment or reimbursement of hospitalisation expenses incurred by you for treatment of Illness, disease or injury in a Hospital as an In-patient and includes cover for:

Hospital (room & boarding and operation theatre) charges,

Admission and registration charges in the hospital, 

Fees of surgeon, anaesthetist, nurses, specialists, 

Diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs etc. 

Pre and Post Hospitalisation Expenses: Reimbursement of medical expenses such as doctor fees, diagnostic tests, medicine costs etc incurred prior to hospitalisation and post hospitalisation, related to illness for which you are hospitalized are covered under the policy.

Pre-Existing Diseases: Payment or reimbursement of expenses incurred in a Hospital for treatment relating to pre-existing Illness or injury after a period of 4 years from the inception of the Policy.

Day Care Treatment: Payment or reimbursement of hospitalisation expenses incurred in case of day care treatment (where 24 hours of hospitalisation is not required due to technologically advanced treatment protocol).

Domiciliary Hospitalisation: Reimbursement of domiciliary hospitalisation expenses for a period exceeding three days for Illness, disease or injury, which in the normal course would require care and treatment at a Hospital or Nursing Home but is actually taken whilst confined at home in India.

Critical Illness: The policy offers an additional 100% coverage in case the insured is diagnosed with any of the specified 20 critical illnesses. This benefit is available after a waiting period of 60 days from the date of inception of the Policy in the first year of cover. A Survival period of 30 days or more post such diagnosis is mandatory. This policy covers Critical illness as a basic cover with lump sum payment and reimbursement options under different plans.

Dread Disease recuperation: Payment of an allowance towards Recuperation expenses incurred by the Insured post discharge from the Hospital, in case the insured contracts any of the specified Critical Illnesses and undertakes treatment for the same in a Hospital.

Transplantation of Organs: Payment or reimbursement of hospitalisation expenses incurred towards donor for a major organ transplant in case the Insured contracts any of the specified critical illnesses requiring major Organ Transplantation surgery.

Benefits under these sections are payable as additional benefits provided a valid claim is admitted under the Hospitalisation expenses benefit section of the Policy. These benefits are applicable irrespective of the number of occurrences during the Policy period and subject to the specific limits applicable under each Section 

1. Hospital Cash Allowance
2. Home Nursing
3. Ambulance Charges
4. In-patient Physiotherapy Charges
5. Recovery Grant
6. Accompanying Person’s Expenses
7. Parent Accommodation as Companion for Insured Child
8. Out-patient Emergency Dental Treatment (arising out of Accident only
9. Out-patient Emergency treatment for Accident
10. Children Education Fund
11. Mortal Remains 

1. Pre-existing Illness / injury / conditions - The benefits will not be available for any condition(s) as defined in the Policy, until 48 months of continuous coverage have elapsed, since inception of the first Policy with the Company.

2. Any benefit under Critical Illness Section within 60 days of the inception date of this Policy. This exclusion, however, does not apply for subsequent renewals with the Company without a break.

3. Hospitalisation expenses incurred for treatment undertaken for Illness within 30 days of the inception date of this Policy This exclusion, however, does not apply for subsequent renewals with the Company without a break.

4. Hospitalisation expenses incurred on treatment of following Illness, injury within the first two years from the inception of this Policy, will not be payable:

• Cataract
• Benign Prostatic Hypertrophy Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignant Dilation and curettage
• Hernia, hydrocele, congenital internal Disease, fistula in anus, sinusitis
• Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lump unless malignant /adenoids and haemorrhoids
• Dialysis required for chronic real failure Gastric and Duodenal ulcers
• Joint replacement Surgeries unless necessitated by Accident

This exclusion, however, does not apply for subsequent renewals with the Company without a break. 

5. Circumcision unless necessary for treatment of a Illness or injury not excluded hereunder, or, as may be necessitated due to an Accident

6. Dental treatment which are not excluded hereunder or Surgery of any kind unless requiring hospitalisation. 

7. Birth control procedures, hormone replacement therapy, treatment arising from or traceable to pregnancy, childbirth including caesarean section and voluntary medical termination of pregnancy during the first 12 weeks from the date of conception. However, this exclusion will not apply to Ectopic Pregnancy proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner.

8. Any fertility, sub-fertility or assisted conception operation.

9. Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, issuance of medical certificates and examinations as to suitability for employment or travel.

10. Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex Syndrome (ARCS) and all Illness / injury caused by and/or related to HIV

11. Illness / injury whilst performing duties as a serving member of a military or a police force.

12. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.

13. Illness, injury, directly or indirectly, caused by or contributed to by nuclear weapons/materials or radioactive contamination.

14. Experimental and unproven treatment.

15. Naturopathy treatment.

16. Any treatment received outside India

This is not the exhaustive list of exclusions, kindly refer to the policy wording document for the detailed list of exclusions.

This policy covers Critical illness with a lump sum payment and reimbursement options under different plans. In case you are already covered for Critical illness, kindly make an informed decision for this policy.

Pre-existing illnesses and injuries are covered after a period of 4 years from the inception of the policy.

This policy will be issued for a period of 12 months and be renewable for subsequent 12 months, if the renewal is consented by the policy holder.

Medical Examination is not required upto the age of 50 years of the insured member for any plan, and upto the age of 55 years for the ₹2,00,000 plan. This is subject to no adverse medical declaration provided by the applicant as a part of the proposal form.

Family floater option is available under all the plans of this policy which includes Self, Spouse and 2 dependent children (over 90 days old and up to 23 years of age).

This policy also provides for cashless servicing across India. Kindly refer to ICICI Lombard General Insurance website for the list of empanelled hospitals for cashless servicing.

Purchase of the insurance product is purely voluntary and is not linked to availment of any other facility from the bank.

Kindly refer to the “Key Exclusions” section to understand the terms not covered under this policy.